Hyperlactation or ‘oversupply’ refers to the production of breastmilk in excess of the volume your baby needs. In the first 2 weeks after birth, many mothers may experience breast engorgement and overabundant breastmilk whilst awaiting regulation of their supply. However, oversupply refers to persistent excess breastmilk production extending beyond this initial postpartum transition.
Newborn babies will typically consume between 500-1200mls of breastmilk in a 24-hour period. A milk production in excess of this may represent an oversupply.
How do I know if I have an oversupply?
Mothers with a breastmilk oversupply may experience multiple breastfeeding complications such as pain, breast inflammation and bacterial mastitis. Babies are at a higher risk for early weaning and lactose overload (not the same as lactose intolerance!).
Here are some common symptoms of breastmilk oversupply (after the milk supply has established):
- Your breasts still feel very full after an adequate breastfeed and even if your baby seems satisfied
- You may also experience a fast milk flow, and notice your baby frequently detaching, coughing, choking or spluttering at the breast during feeds
- You may have reoccurring breast inflammation or bacterial mastitis
It is also important to note that symptoms of a breastmilk oversupply may coincide with other symptoms. For example, your breasts may be engorged and you may experience recurrent mastitis without necessarily having a breastmilk oversupply.
What causes breastmilk oversupply?
There are several factors that regulate breastmilk production:
- Amount of glandular (milk-producing) tissue available in each individual breast
- Frequency and effectiveness of milk removal
- Complex nerve pathways and the involvement of many hormones
The causes of breastmilkoversupply may be:
- Self-induced – Mother may be stimulating a milk production in excess of what is needed
- ‘Iatrogenic’ – oversupply as a result of healthcare professional advice/contribution
- ‘Idiopathic’ – oversupply with unknown cause
Management of breastmilk oversupply
1. Reduce and/or cease unnecessary breast stimulation.
For mothers who are directly breastfeeding: The best way to initially approach oversupply resolution is to breastfeed your baby on demand and avoid any additional breastmilk expressing. Demand feeding can help resolve most cases of self-induced and iatrogenic breastmilk oversupply.
For mothers who are exclusively expressing breastmilk: If you are expressing breastmilk and experiencing an oversupply of breastmilk you will need to immediately begin reducing the number of times you express in a day (and also the length of time you express too!). You should just express to the exact amount your baby needs – although it may take time to do so safely, for some mothers.
2. Check your baby’s breast attachment
Sub-optimal breastfeeding attachment can lead to many breastfeeding complications. It is important that your baby is able to attach effectively to the breast without nipple or breast pain.
3. Block feeding
Block feeding refers to breastfeeding (or expressing) from just one breast for a specific period of time. This helps use the natural regulatory process of the lactating breast to reduce milk production.
There are several block feeding techniques suggested in scientific literature – but the Academy of Breastfeeding Medicine recommends the following technique:
- Direct breastfeeding or expressing from a single breast over a period of 3 hours, alternating breasts each cycle or ‘time block’.
- Feeding by ‘time blocks’ should only occur during the day. During the night you can continue feeding from one or both sides alternating as before.
- If the untouched breast becomes too uncomfortable/full during a time block, then express a small volume of breastmilk for comfort.
- Be mindful of breast health and monitor for early signs of breast inflammation (redness and/or pain)
If at any point you are not sure if the breast is becoming inflamed, cease block feeding and return to feeding alternatively on demand. It would also be of benefit for you to seek individual support from a lactation consultant to help you assess your breast health and wellbeing.
4. Laid-back (biological) breastfeeding
While awaiting your milk production to normalise, you can try feeding while laying back. This can give your baby better control of the flow of milk and set his/her own pace
5. Avoid herbal therapies and prescription galactagogues (milk increasing medications)
Sadly, this also means the Milky Goodness cookies might also need to return to the cupboard for a while! If you are taking medication, domperidone (also called Motilium) you’ll need to speak to your doctor or lactation consultant about reducing this as soon as possible!
6. Seek experienced specialist advice before considering medication to reduce your milk supply
Selection of prescription medications to help reduce breastmilk supply should be only given in very specific circumstances. Consideration of factors such as baby age, medication interactions, patient medical history/preferences and allergies should be explored.
Written by Keryn Thompson, RM & IBCLC (L-301766)
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